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David Baxter

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Schizoid personality disorder
Dec 8, 2006
By Mayo Clinic Staff

Schizoid personality disorder is a condition in which people avoid social activities and consistently shy away from interaction with others. People with the disorder are generally loners with a profound inability to connect with others and form personal relationships.

To others, people with schizoid personality disorder may appear aloof, dull or humorless, and they are often ignored in social settings. People with the disorder show a flattened or restricted range of emotions, and can appear indifferent to what's going on around them. However, their inner life can be rife with a deep emotional need, sensitivity and confusion about the world around them.

It's unclear whether people with schizoid personality disorder willingly embrace isolation, or secretly crave intimacy but find interpersonal relations too distressing. What is clear is that people with schizoid personality disorder withdraw at the expense of relationships with people they care about, even spouses.

The cause of schizoid personality disorder is unknown, although genetics and environmental factors both come into play. It's difficult to treat people with schizoid personality disorder because they consider therapy intrusive. However, some therapeutic approaches and medications may help relieve some symptoms of this chronic condition.

Signs and symptoms
People with schizoid personality disorder are loners. Generally they:

  • Choose activities that don't require interaction with others
  • Prize solitude and independence
  • Are often unable to respond to normal social cues in social settings
  • Harbor little desire for sexual experiences with others
  • Can appear dull or indifferent to others
  • Are followers rather than leaders in groups
  • Some tendencies can appear in childhood and continue through adolescence and into early adulthood.
People with schizoid personality disorder may appear detached and aloof to outsiders, but some experts believe that they're actually quite sensitive and experience a deep longing for intimacy. However, people with schizoid personality disorder either are incapable of initiating and maintaining a personal relationship, or find themselves suffocated or anxious in the company of others. Thus they retreat into their inner worlds and view their environs with great confusion, or seek relationships for security but break away repeatedly.

Often, people with schizoid personality disorder populate the fringes of life ? working the midnight shift at a grocery store or running the projector at a movie theater. They may live in the basement of their elderly parents' homes or in some cases become homeless, refusing outreach services.

Symptoms of schizoid personality disorder include:

  • Emotional coldness or aloofness
  • Indifference to praise or criticism and the feelings of others
  • Close friendships with no more than one or two people, including family members
  • Social withdrawal, or continual avoidance of social activities
  • Flattened emotions or lack of expressivity
  • Inability to experience pleasure (anhedonia)
  • General feeling of discomfort or restlessness (dysphoria)
  • Having little to say
  • Lack of motivation or persistence (avolition)
  • Tendency toward underperformance in school or work settings
The schizophrenic spectrum
Schizoid personality disorder is considered part of the "schizophrenic spectrum" of disorders, which includes schizotypal personality disorder and schizophrenia. These conditions all have similar symptoms, such as an incapacity for social relations and emotional inexpressiveness. The main distinction is that people with schizoid personality don't usually experience the perceptual distortions, paranoia or illusions characteristic of schizotypal personality or the psychotic episodes of schizophrenia.

Although their speech lacks enthusiasm, what people with schizoid personality disorder say is rarely abnormal or odd, as in the conversational patterns of people with schizotypal personality disorder.

Causes
The exact causes of schizoid personality disorder are unknown, although a combination of genetic and environmental factors ? particularly in early childhood ? are thought to contribute to development of all personality disorders.

A person with schizoid personality disorder may have had a parent who was cold or unresponsive to emotional needs, or might have grown up in a foster home where there was no love. Or, because people with schizoid personality disorder are often described as being hypersensitive or thin-skinned in early adolescence, a person with schizoid personality disorder may have had needs that others treated with exasperation or scorn.

A family history ? such as having a parent who has any of the disorders on the schizophrenic spectrum ? also increases the chances of developing the disorder.

Risk factors
Personality development is affected by genetic tendencies as well as environmental factors, particularly during childhood. Factors that increase the risk of developing schizoid personality disorder include:

  • Having a parent or other relative who has schizoid personality disorder
  • Experiencing a childhood environment of neglect or scorn
  • Suffering child abuse or mistreatment
  • Having an emotionally detached parent
  • When to seek medical advice
Because personality tends to become entrenched with age, treatment for a personality disorder has the possibility of being more effective if it begins as early as possible.

People with schizoid personality disorder tend to shun interaction with medical professionals and are likely to seek help only at the urging of relatives or teachers or intervention by the legal system.

If you suspect someone may have schizoid personality disorder, be on the lookout for signs and symptoms such as consistent emotional detachment and social isolation. You might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional.

Screening and diagnosis
There are no laboratory tests for schizoid personality disorder, and diagnosis usually comes after a thorough clinical interview. During this interview, the doctor will ask questions about symptoms and mental well-being, and take a medical, psychiatric and social history. A physical examination can help rule out other conditions, and a mental health professional will likely be consulted for further evaluation.

In order for someone to receive a diagnosis of schizoid personality disorder, he or she must meet at least four of the following criteria:

  • Neither desires nor enjoys close relationships, including being part of a family
  • Almost always chooses solitary activities
  • Has little, if any, interest in sexual experiences with another person
  • Takes pleasure in few, if any, activities and rarely experiences strong emotions
  • Lacks close friends or confidantes other than first-degree relatives
  • Appears indifferent to praise or criticism
  • Shows emotional coldness, detachment or flattened emotions
In addition, the symptoms must not occur exclusively during a bout of schizophrenia, a mood disorder with psychotic features, another psychotic disorder or a pervasive developmental disorder (such as autism or Asperger's syndrome). Also, a diagnosis of schizoid personality disorder may not be appropriate should symptoms be due to the direct physiological effects of a general medical condition.

Further complicating a diagnosis is that the symptoms of schizoid personality may resemble autism or Asperger's syndrome.

Complications
People with schizoid personality are at an increased risk of:

  • Developing schizotypal personality disorder, schizophrenia or other delusional disorder
  • Drug addiction, particularly to psychedelic drugs
  • Alcohol addiction
  • Major depression
  • Anxiety disorder
  • Panic disorder
  • Social phobia
  • Other personality disorders
Further, because people with schizoid personality disorder may have trouble interpreting and responding to social stimuli, they may have trouble warding off the predatory behavior of other people. As a result, they may be more prone to victimization than are most other people.

Treatment
Schizoid personality disorder can be difficult to treat because people with the disorder are inclined to go their own way and prefer not to come in contact with medical professionals. Further, they sometimes settle into complacency about their emotionally impoverished existence.

When they do come into treatment ? either by family insistence or by the legal system ? they can have trouble communicating with a therapist and react in a bland, detached manner. However, when a doctor shows respect for their personal space and private thoughts, people with a schizoid personality can respond effectively to treatment.

  • Medications. There's no specific drug treatment for schizoid personality. However, doctors may prescribe medications to help alleviate some symptoms, as well as associated conditions such as anxiety and depression. For example, the psychological inability to experience pleasure can be treated with bupropion (Wellbutrin). Risperidone (Risperdal) or olanzapine (Zyprexa) can help with flattened emotions and social problems.
  • Psychotherapy. Cognitive behavior therapy ? which focuses on adjusting the thinking and behaviors that cause problems ? can help a person with schizoid personality disorder develop social skills and increase sensitivity to interpersonal cues. For example, a person with schizoid personality disorder might learn appropriate ways to react when faced with certain stimuli, such as being introduced to someone at a party. The goal of treatment is to be supportive and practical, and to alleviate social anxiety and isolation.
  • Group therapy. Treatment can be more effective when people with the disorder can interact with others in practicing new interpersonal skills. Group therapy may also offer people with schizoid personality disorder a support structure and increase social motivation. However, group therapy isn't effective for everybody.
Prevention
Because schizoid personality disorder originates with the family and childhood environment, early intervention may help diminish the development of problem behaviors.
 

Halo

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I found this article quite interesting and was wondering whether if one was in therapy whether this disorder would be easy to diagnose by a trained professional. I guess I ask because some of the symptoms of this disorder seem to be similar to that of social anxiety and wonder whether there is a noticeable difference between the two.
 

David Baxter

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It's beyond (more extreme than) social anxiety:

Diagnostic criteria for 301.20 Schizoid Personality Disorder

A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

(1) neither desires nor enjoys close relationships, including being part of a family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others
(7) shows emotional coldness, detachment, or flattened affectivity​

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder and is not due to the direct physiological effects of a general medical condition.
 

Halo

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It's beyond (more extreme than) social anxiety

So if it is more extreme than social anxiety, it is probably more easy to diagnose then right?
 

David Baxter

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I don't know about that. I don't think either are all that hard to diagnose.
 

braveheart

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...where someone withdraws, but secretly longs for companionship and warmth.... is avoidant PD. That's what I have read, anyway. I have traits of both in my personality.
 

Bones

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I definitely think that I have this to a certain degree.
Mainly I just hate group environments and I want nothing to do with them.
But I'm generally OK with people on a individual level, but not always.
Also I always score high on this in personality disorder tests. :rolleyes:
 

David Baxter

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I definitely think that I have this to a certain degree.
Mainly I just hate group environments and I want nothing to do with them.
But I'm generally OK with people on a individual level, but not always.
Also I always score high on this in personality disorder tests. :rolleyes:

Don't place any confidence in online tests.

There's a big difference between schizoid p.d. and social anxiety.
 
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After reading this article, it looks like i fit the bill to a certain degree. I understand that the possible "complications" of this personality disorder can give rise to anxiety disorders, depression, addiction problems etc... which means there can be comorbidity of disorders.

I'm a firm believer that if a person is happy "as is" and not hurting anyone else by their behavior, no pathology exists. My thought is that "complications" can arise if family and social expectations are pressuring someone to be something he/she is not to the breaking point.

If, on the other hand, a person is suffering because he/she feels trapped in a cycle of thoughts and behaviors that restricts one's freedom to be the best he/she can be, this person would indeed need full support to operate some changes.

If it ain't broken, don't fix it...

Jos?e
 

Bones

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Don't place any confidence in online tests.

I have actually thought that I've had the Schizoid p.d. to some degree long before doing those tests.
I have only just recently done a few p.d. disorder tests.

From reading the descriptions of the Schizoid, I think much of it describes me fairly well.

But, as said in many other posts, self-diagnoses can be misleading so maybe I'm wrong.
 

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I have been diagnosed with Schizoid PD but have also been told that it is a diagnosis used to describe my 'difficulties' with life, and that i move up and down the Schizophrenic spectrum according to stress and depressive episodes. I have a lot more in common with Schizotypal and although my Psych agrees with that, she is reluctant to diagnose me with it. I have all the Schizoid symptoms , depression ,plus some avoidant and paranoid symptoms and i hear voices, so i guess it just goes to show that we are all individuals and sometimes it is hard to fit us into boxes.:). Even as a Schizoid i do want to be with people , in a limited way, but find it emotionally and physically knackering to do so even for an hour.I am about to have therapy as i have no wish to stay 'Schizoid' for the rest of my life and when i was younger i did enjoy others company, but also prized my time alone aswell.

Lottie
 

David Baxter

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That's an important point, Lottie:

Anxiety and stress have a way of worsening symptoms for pretty much all mental health conditions, from panic disorder to OCD to bipolar disorder to schizophrenia.

One implication is that it's important to learn good coping skills and stress management skills, and to try to find ways to minimize stress in your life as much as you can.
 

lottie

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That's so true !. Unfortunately anything seems to stress me at the moment so it would be hard to avoid every trigger. I am just starting to go to a support group which will hopefully help with my terrible social anxiety and complete lack of people skills and i am just about to start therapy aswell. Both of these things should help with any luck, but the stress involved may also tip me over into worse illness, but that is a chance i have to take if i want my life to change. Needless to say i am scared witless that the 'voices' will take over again and start to convince me that i am supposed to hurt someone. I find that intolerable as i am a gentle pacifist. Hopefully they will leave me alone enough to connect to someone and even make friends.



Lottie
 

ladylore

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Something that has helped Lottie to deal with panic is simply to know and to say to myself "my body is doing it's thing at the moment. It is only a panic attack and it will be over soon."

This was taught to me by my therapist. It may sound corny but it does work most of the time. Just identifying what is going helps. It may work if the voices come back - you can already distinquish them as just voices - as you have said, you are a gentle soul. :)
 

solitary man

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I was just diagnosed with this, and I've reading all the symptoms, and I have to agree with all them.

Funny thing is, I work in retail and have no problems with socializing with people when the situation calls for it, but I prefer to be by myself most of the time.

When I am amongst strange settings and crowds, I know I retreat within myself, and I come across as being aloof, not to mention tongue tied.

I never feel more alone than when I am in overcrowded situations.

I don't let a lot people into my life, and when I do, I have a hard time knowing how to keep them in.
 

solitary man

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I've been trying to locate a support group for Schizoid personalities in Toronto, but haven't come across anything as yet.

I did locate 1 forum online, but the vibe that I get from them is that they're happy complaining about everyone and not attempting to make any changes in their lives.

Thanks in advance.
 

Halo

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Solitary Man

When I have a little more time and am more awake, I will do a few searches and see what, if anything, I can find. Hopefully there are some good resources and support out there to be had.
 

lottie

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I've been trying to locate a support group for Schizoid personalities in Toronto, but haven't come across anything as yet.

I did locate 1 forum online, but the vibe that I get from them is that they're happy complaining about everyone and not attempting to make any changes in their lives.

Thanks in advance.

I think i know what forum you are talking about and i agree wholeheartedly. There also always seems to be a competition on who is the most Schizoid on there and also if you have any symptoms not listed in the ICD or DSM then you are not a ''real' Schizoid in their eyes. I hear voices but still have the diagnosis Schizoid Personality disorder. I also have OCD and anxiety issues and believe that Schizoids vary just as much as ''normal'' people do.

lottie
 

kaiser001

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For 7 years I was hammered with "voices." The subject matter that one hears is some of the most horrible stuff you can imagine. It is as if somebody has your entire history of experiences loaded up on a database, from which they can choose (random or relevant) what memories/experiences to hurt you with.

These memories appear to be 1-2 second clips of visual/audio that appear within the minds eye (not as a hallucination).


Baxter: The symptoms you listed are helpful. In my case those below are very accurate; with some symptoms more persistant than others.


Emotional coldness or aloofness
Indifference to praise or criticism and the feelings of others
Close friendships with no more than one or two people, including family members
Social withdrawal, or continual avoidance of social activities
Flattened emotions or lack of expressivity
Inability to experience pleasure (anhedonia)
General feeling of discomfort or restlessness (dysphoria)
Having little to say
Lack of motivation or persistence (avolition)
Tendency toward underperformance in school or work settings



I find it humiliating being unable to form friendships/relationships at this time. I was alwasy eager to be around people and make friends as a child. I think it will just take time.


Kaiser
 

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